Ekéus C, Norman M, Åberg K, Winberg S, Stolt K, Aronsson A
a Department of Women's and Children's Health, Division of Reproductive Health , Karolinska Institutet , Stockholm , Sweden.
b Department of Clinical Science , Intervention and Technology, Karolinska Institutet , Stockholm , Sweden.
J Matern Fetal Neonatal Med. 2019 Jan;32(2):265-270. doi: 10.1080/14767058.2017.1378328. Epub 2017 Sep 22.
The routine to deliver almost all term breech cases by elective cesarean section (CS) has continued to be debated due to the risk of maternal and neonatal complications. The aims of the study were (1) to investigate if mode of delivery impacts on the risk of morbidity and mortality among term infants in breech presentation and (2) to compare the rates of severe neonatal complications and mortality in relation to presentation and mode of delivery.
This population-based cohort study used data from the Swedish Medical Birth Register. All women (and their newborn infants) with singleton pregnancies who gave birth at term to an infant in breech (n = 27,357) or cephalic presentation (n = 837,494) between 2001 and 2012 were included. Births with vacuum extraction and induced labors were excluded, as well as antepartum stillbirths, births with infants diagnosed with congenital malformations and multiple births.
On one hand, the rates of neonatal complications and mortality were higher among infants born in vaginal breech compared to the vaginal cephalic group. On the other hand, after CS, the rates of all neonatal complications under study and neonatal mortality were lower among infants in breech presentation than in those in cephalic presentation. After adjustment for confounders, infants delivered in vaginal breech had 23.8 times higher odds AOR (ratio) for brachial plexus injury, 13.3 times higher odds ratio for Apgar score <7 at 5 min, 6.7 times higher odds of intracranial hemorrhage (ICH), or convulsions and 7.6 higher odds ratio for perinatal mortality than those delivered by elective CS.
Despite a probable selection of women who before-hand were considered at low risk and, therefore, could be recommended vaginal breech delivery, infants delivered in vaginal breech faced substantially increased risks of severe neonatal complications compared with infants in breech presentations delivered by elective CS. Key message Vaginal breech delivery is associated with increased risk for severe neonatal complications.
由于存在孕产妇和新生儿并发症风险，几乎所有足月臀位病例均通过择期剖宫产（CS）分娩的常规做法一直存在争议。本研究的目的是：（1）调查分娩方式是否会影响足月臀位婴儿的发病和死亡风险；（2）比较与胎位和分娩方式相关的严重新生儿并发症和死亡率。
这项基于人群的队列研究使用了瑞典医学出生登记处的数据。纳入了2001年至2012年间所有单胎妊娠且足月分娩臀位婴儿（n = 27357）或头位婴儿（n = 837494）的妇女（及其新生儿）。排除了使用真空吸引和引产的分娩，以及产前死产、诊断为先天性畸形婴儿的分娩和多胎分娩。
一方面，与阴道头位组相比，阴道臀位分娩的婴儿中新生儿并发症和死亡率更高。另一方面，剖宫产术后，臀位婴儿中所研究的所有新生儿并发症发生率和新生儿死亡率均低于头位婴儿。在对混杂因素进行调整后，阴道臀位分娩的婴儿发生臂丛神经损伤的优势比（AOR）比择期剖宫产分娩的婴儿高23.8倍，5分钟时阿氏评分<7的优势比高13.3倍，颅内出血（ICH）或惊厥的优势比高6.7倍，围产期死亡率的优势比高7.6倍。
尽管可能选择了之前被认为风险较低、因此可推荐阴道臀位分娩的妇女，但与择期剖宫产分娩的臀位婴儿相比，阴道臀位分娩的婴儿面临严重新生儿并发症的风险大幅增加。关键信息：阴道臀位分娩与严重新生儿并发症风险增加相关。
